Smarter Oral Care

Apical Periodontitis: Symptoms and Treatment

Periradicular, periapical or apical periodontitis can be defined as inflammation of all the supporting structures of the teeth in the area surrounding the apex of the tooth. Periapical inflammation is usually due to tooth infection which characteristically causes pain of tooth in its socket. It is often accompanied by destruction of bone and occasionally, the root apex of tooth. However the periapical tissue has the ability to heal if the cause of inflammation is removed. Periapical periodontitis can be divided into acute and chronic apical periodontitis.

Causes of apical periodontitis

Infection – by far the most common cause, bacteria causes decay of tooth which leads to pulp inflammation (pulpitis) and death of the pulp (the soft inner part of the tooth). If pulpitis is not treated; bacteria, bacterial toxins or products of inflammation can extent down the root canal and cause periodontitis.

Trauma – any direct blow to the tooth can sometimes cause the pulp of the tooth to die and it may become infected by bacteria from the gum margins, leading to apical periodontitis. A sudden bite on a hard object, undue pressure during orthodontic treatment or a filling that is high can sometimes cause acute periodontitis though usually short-lived.

Root canal treatment – mechanical instrumentation through the tooth root during treatment or chemical irritation from root-filling materials may result in inflammation of the periapical region.

Acute apical periodontitis

Signs and symptoms of acute apical periodontitis

The affected tooth is often having a large decay area, a filling or may be discolored due to a dead pulp in the tooth.

Possible complications of chronic apical periodontitis

Pus formation and abnormal opening from the mouth to the outer face (sinus)

Acute worsening of the disease

Treatment of chronic apical periodontitis

Similar to acute apical periodontitis, extraction or root canal treatment are the main options. Persistence of chronic periodontitis after root canal treatment is usually due to technical faults during the procedure and removal of the apex of the tooth may be advised.